tbuckley/cabot-search huggingface dataset:
Abstract 11383: Risk of Stroke Among Patients With Left Ventricular Thrombus Undergoing Percutaneous Coronary Intervention: A 5-Year Retrospective Review Using Real-World Data
Authors: Mohanad Shehadeh, Alaa Rahhal, Ashraf Ahmed, Osama AlKhalaila, Mohamed Abdelghani, Khaled Shunnar, Ahmed Mahfouz, Sumaya Alyafei, Abdulrahman Arabi
Journal: Circulation (2022)

Introduction: Left ventricular thrombus (LVT) is a well-established risk for ischemic stroke. Nevertheless, it remains uncertain if percutaneous coronary intervention (PCI) in the setting of LVT further augments the risk of stroke. Therefore, in this study, we evaluated the risk of stroke among patients with LVT undergoing PCI. Methods: This retrospective observational cohort study included the patients admitted with LVT to Heart Hospital in Qatar between April 1, 2015 and March 31, 2020. The study population was divided into two groups: (1) patients with LVT who underwent PCI; (2) patients with LVT who did not undergo PCI. The primary outcome evaluated was stroke during the index admission, and the secondary outcomes were in-hospital mortality, all-cause mortality, and stroke at 12 months post discharge. Logistic regression was used to determine the risk of stroke associated with PCI among patients with LVT. A p&lt;0.05 indicated statistical significance. Results: Of the 210 patients included, 119 underwent PCI, while 91 patients did not undergo PCI. Most of the patients were Asian (67%), male (96%) with a mean age of 56 yearsIschemic cardiomyopathy was the main etiology of LVT in both groups (96% in the PCI group and 80% in non-PCI group). Around 70% of the patients in the PCI group underwent intervention to the left anterior descending artery. During the index admission, stroke among patients with LVT did not differ between the PCI and non-PCI groups (5% versus 3.3%; odds ratio (OR) 1.6, 95% confidence interval (CI) 0.34-6.4, p=0.539; adjusted OR 0.9, 95% CI 0.09-10.6, p=0.968. Similarly, in-hospital mortality, all-cause mortality, and stroke at 12 months did not differ between the study groups. Conclusion: Performing PCI among patients with LVT was not associated with increased risk of stroke during admission or at 12 months in comparison to patients who did not undergo PCI, which may reassure cardiologists to safely perform PCI among patients with LVT and defer delaying the procedure among patients with acute coronary syndrome due to presumed risk of stroke.
Abstract 11626: A Hepato-Cardiac FGF21 Axis Activates a Cardiac FGF21 Autocrine Mechanism That Causes Hypertrophy With Pressure Overload
Authors: Sobuj Mia, Rafailia Sidiropoulou, Matthew Hoffman, Eftychia Markopoulou, Craig H Selzman, Stavros G Drakos, Dipayan Chaudhuri, Konstantinos Drosatos
Journal: Circulation (2022)

FGF21 is expressed mainly in the liver and other organs, including skeletal muscle and heart. It exerts its actions by binding to its receptors (FGFR) and the co-receptor β-klotho. Despite evidence about protective action of FGF21 in different animal disease models, elevated plasma FGF21 levels have been reported in patients with heart failure. Thus, it remains unknown whether elevation in human heart failure is part of the disease’s pathophysiology or a protective response. Staining of heart sections from end-stage heart failure patients showed increased FGF21 that correlated with higher plasma FGF21 levels. To assess the relative contribution of cardiac and extracardiac FGF21 in heart failure, we generated 3 animal models with cardiomyocyte- (CM-FGF21-KO), hepatocyte- (Alb-FGF21-KO) or skeletal muscle-specific FGF21 (MLC-FGF21-KO) deletion and subjected them to transverse aortic constriction (TAC) for 3 days, 2, 4, and 8 weeks. Hepatic expression and plasma levels of FGF21 were increased 3 days post-TAC. Cardiac FGF21 expression was also increased after 2 weeks of TAC. Surprisingly, the pro-hypertrophic effect of TAC was abolished in both Alb-FGF21-KO and CM-FGF21-KO mice. Interestingly, cardiac FGF21 expression was not increased in CM-FGF21-KO mice despite the high plasma FGF21 levels. The MLC-FGF21-KO mice were not protected. Thus, cardiomyocyte FGF21 upregulation mediates cardiac hypertrophy in response to pressure overload. To investigate if cardiomyocyte FGF21 expression is controlled by FGF21 that is released from the liver, we treated human AC16 cells with recombinant FGF21, which increased endogenous FGF21 mRNA and protein, pointing to an autoregulatory FGF21-based induction of cardiac FGF21 expression. This auto-regulatory loop was potentiated by increased expression of cardiac FGFR1 in wild-type mice subjected to TAC that was attenuated in CM-FGF21-KO mice. Accordingly, we observed increased pro-hypertrophic cardiac signaling (pAMPK, pERK,Bnp, Tnfα) in wild-type mice with TAC, but not in CM-FGF21 KO mice. Conclusively, a hepato-cardiac FGF21-based signaling axis governs cardiomyocyte FGF21 expression, which accounts for cardiac hypertrophy. Inhibition of either hepatic or cardiomyocyte FGF21 is cardioprotective.
Abstract 11994: Reduced versus Standard Dose Apixaban in Patients With Atrial Fibrillation and Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention: Insights From the AUGUSTUS Trial
Authors: Marat Fudim, Renato D Lopes, Daniel M Wojdyla, Roxana Mehran, Mohammad S Khan, Christopher B Granger, Shaun G Goodman, Ron Aronson, Stephan Windecker, John H Alexander
Journal: Circulation (2022)

Background: Patients in AUGUSTUS (n=4614) taking apixaban without aspirin had less bleeding and fewer hospitalizations with no significant increase in ischemic events than those taking VKA, aspirin, or both. It is safe and efficacious to reduce apixaban from 5 mg to 2.5 mg twice daily in patients with AF and ≥2 of the following: age ≥80 years, weight ≤60 kg, serum creatinine ≥1.5 mg/dL. Data on reduced versus standard dose apixaban in patients with AF and ACS and/or PCI are limited. Methods: We assessed how many patients receiving apixaban 2.5 mg met the dose reduction criteria. We compared major or CRNM bleeding, death or rehospitalization, and death or ischemic events in those who appropriately received 2.5 mg apixaban, inappropriately received 2.5 mg apixaban, and appropriately received 5 mg apixaban. We determined the association of apixaban versus warfarin on bleeding and ischemic events in patients appropriately assigned 2.5 mg apixaban and appropriately assigned 5 mg apixaban. Results: Of 2290 patients assigned apixaban, 229 received 2.5 mg and 98 (43%) of those met reduced dose criteria. Rates of major/CRNM bleeding, death or rehospitalization, and death or ischemic events were higher in patients appropriately receiving 2.5 mg apixaban (13.7%, 34.7%, 12.2%) compared with those inappropriately receiving 2.5 mg apixaban (10.5%, 32.5%, 12.3%) and appropriately receiving 5 mg apixaban (11.0%, 23.0%, 5.7%). Compared with VKA, 2.5 mg apixaban, when used appropriately, resulted in similar or greater benefits than 5 mg apixaban for major/CRNM bleeding, death or rehospitalization, and death or ischemic events (Table). Conclusion: Of those in AUGUSTUS who received 2.5 mg apixaban, fewer than half met the reduced dose criteria. In patients with AF and recent ACS or PCI, appropriate use of reduced dose apixaban was associated with a lower risk of bleeding and similar rates of rehospitalization and ischemic outcomes compared with VKA, similar to that for standard dose apixaban.
Abstract 12104: Pediatric Hypertrophic Cardiomyopathy With Left Ventricular Systolic Dysfunction: Insights From the Sarcomeric Human Cardiomyopathy Registry (SHaRe)
Authors: Sarah Abou Alaiwi, Thomas M Roston, Christoffer Vissing, Peter Marstrand, Brian Claggett, Victor Nauffal, Victoria N Parikh, Adam S Helms, Jodie Ingles, Daniel L Jacoby, Neal K Lakdawala, Michelle Michels, Anjali T Owens, Euan A Ashley, Alexandre Pereira, Joseph Rossano, Sara Saberi, Christopher Semsarian, James S Ware, Erin Miller, Samuel Wittekind, Mark W Russell, Sharlene Day, iacopo olivotto, Carolyn Ho
Journal: Circulation (2022)

Introduction: Left ventricular systolic dysfunction (LVSD, LV ejection fraction (LVEF) &lt;50), occurs in ~8% of adults with hypertrophic cardiomyopathy (HCM) and is associated with poor prognosis. However, the incidence and prognosis of LVSD in pediatric patients with HCM (&lt;18 years old) is poorly understood. Methods: Patients in SHaRe with pediatric HCM were included. Time-to-event analyses were performed to estimate 1) cumulative incidence of LVSD in pediatric vs adult HCM (Kaplan Meier), 2) predictors of incident LVSD in pediatric HCM (Cox-proportional hazards) and 3) a composite outcome of all-cause mortality, heart transplant and left ventricular assist device implant in pediatric HCM. Results: In total, 1296 pediatric HCM patients (34% females, median 12.2 years at diagnosis, median 8.3 years follow-up) were included. LVSD occurred in 155 (12%) of patients with 29% (n=45) having LVSD at the first SHaRe visit and 22% (n=34) developing LVSD &lt;18 years old. At 5-year follow-up, the cumulative incidence of LVSD was 9% [8-11%]. Predictors of incident pediatric LVSD included HCM before age 12 (HR 2.0 [1.3-3.0]), female sex (HR 0.49 [0.32-0.77]), P/LP variants in thick filament genes (HR 2.6 [1.1-4.2], multiple P/LP variants (HR 9.1 [CI 2.9-29.1]) and baseline LVEF (HR 0.63 [0.58-0.68], per 5 %-points increase). Pediatric HCM was associated with higher rate of LVSD compared to adult-onset HCM (n=6428, median HCM at age 49 years, median follow-up of 7.1 years), p=0.05 (Figure 1). The composite endpoint occurred in 41% (n= 63/155) of children with HCM and subsequent LVSD. In patients with LVSD, female sex (HR 2.44 [1.41-4.17]) and baseline LVEF &lt;35% (HR 4.0 [2.4-6.9]) were independently associated with the composite outcome. Conclusion: Females were less likely to develop LVSD but more likely to have adverse outcomes once they do. Clinical outcomes are adverse, and greater recognition of and surveillance for LVSD in pediatric HCM are warranted.
Abstract 12: Identifying Emergency Medical Service Agencies In Black And Hispanic Communities With High Cardiac Arrest Survival Rates
Authors: Anezi Uzendu, Philip Jones, John Spertus, Paul S Chan
Journal: Circulation (2022)

Background: Black and Hispanic individuals have lower survival rates for out-of-hospital cardiac arrest (OHCA). Whether there are Emergency Medical Service (EMS) agencies in Black and Hispanic communities with high survival rates for OHCA is unknown but critical to identifying strategies to reduce racial and ethnic disparities in OHCA survival. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified adults with non-traumatic OHCA during 2015-2019. EMS agencies were categorized as working in Black/Hispanic communities if &gt;50% of residents in their catchment area were Black or Hispanic. Using hierarchical logistic regression, we calculated risk-standardized survival rates (RSSR) to hospital admission for OHCA in each EMS agency, adjusted for patients’ age, sex, witnessed arrest status, presumed arrest etiology, initial cardiac arrest rhythm, and arrest location. We then examined the distribution of EMS agencies that work in Black/Hispanic communities across quartiles of OHCA survival. Results: Among 764 EMS agencies (258,342 OHCAs), the median RSSR was 27.4% with an absolute difference of &gt;10% across quartiles (median 22.4% in the lowest vs. 32.9% in the highest quartile; 191 EMS agencies in each quartile). There were 82 EMS agencies working in Black/Hispanic communities overall, with 26 (31.7%) in the lowest RSSR quartile and 15 (18.3%) in the highest. After further adjustment for agency-level rates of bystander CPR, EMS response time and termination of resuscitation practices, there remained 29 (35.4%) EMS agencies in the lowest RSSR quartile and 16 (19.5%) in the highest. Conclusion: EMS agencies working in Black and Hispanic communities have lower prehospital survival for OHCA, although high-performing agencies exist. Identifying best practices at EMS agencies with the highest prehospital survival rates, particularly among agencies serving Black and Hispanic communities, has the potential to improve overall OHCA survival and reduce existing survival disparities.
Abstract 12728: The Addition of Social Determinants of Health Improves the Predictive Accuracy of the Pooled Cohort Equations for 10-year Ascvd Events in African Americans
Authors: J G Hammond, RJ Waken, Mario Sims, Kamal Henderson, Karen E Joynt Maddox
Journal: Circulation (2022)

Introduction: The gold standard risk prediction tool for atherosclerotic cardiovascular disease (ASCVD), the Pooled Cohort Equations (PCE) underestimates risk among the socially disadvantaged, yet social determinants of health are absent from the PCE. This may be contributing to racial inequities in CVD since due to systemic and structural racism, socioeconomic disadvantage is disproportionately concentrated in African American (AA) communities. This analysis aimed to determine whether SDOH variables were important for the prediction of 10-year ASCVD risk in a large cohort of AA and to test whether the addition of these variables improved PCE model performance. Methods: Retrospective observational study of 3,470 Jackson Heart Study (JHS) participants aged 40-79 years old without prior ASCVD at baseline study visit. 10-year ASCVD event was defined as stroke, MI, or death from MI. First, we used competing risk random survival forests to determine variable importance of risk factors, then we used cox-proportional hazards to identify which variables among those found to be important, were independently associated with our outcome. We used time dependent AUC to compare the performance of PCE alone to models with the PCE plus SDOH to assess concordance with the true event rates for prediction of 10-year ASCVD. Results: Our sample was 35% male, 100% AA and 46% of participants had an income of &lt;$35K/year. Of 30 SDOH factors tested, the following 6: BMI, depression, weekly stress, insurance status, family income, and neighborhood violence were determined most important for prediction and were independently associated with 10-year ASCVD risk. In this sample, the PCE only model had an AUC of 0.822; adding a limited panel of SDOH factors - income, insurance status and occupation, increased the AUC to 0.859, but this improvement was only statistically significant at the 0.10 level (p=0.093). The model adding the full 6 SDOH risk panel to the PCE, saw the highest AUC at 0.863 (p=0.029). Conclusions: Adding SDOH risk factors to the PCE improved risk prediction. These findings should be explored in a larger database to determine if adding SDOH to the PCE can improve risk prediction for ASCVD events among vulnerable populations and guide more optimal use of prevention strategies.
Abstract 11491: Clinical Time Course of Post-Acute Sequelae of SARS-CoV-2 Cardiovascular Syndrome
Authors: Mark C Beatty, Amanda K Verma
Journal: Circulation (2022)

Introduction: Post-acute sequelae of SARS-CoV-2 cardiovascular syndrome (PASC-CVS) is a heterogeneous disorder of post-COVID syndrome that involves a wide range of cardiovascular symptoms including palpitations, chest pain, dyspnea and dizziness. The clinical time-course of PASC-CVS is not well characterized. We sought to understand predictors of time to symptom improvement for patients with PASC-CVS. Methods: Patients with PASC-CVS undergoing evaluation in a dedicated post-COVID cardiology clinic were recruited after informed consent. Information was obtained from chart review and included demographics, comorbidities, symptoms, time of infection to time of presentation to the clinic and time to improvement in symptoms. A multivariate linear regression model was used to determine predictors of time to improvement. Results: A total of 144 consecutive patients were included that had complete records available for review. Average age was 46 years, 74% were female and 94% were Caucasian. Comorbities included obesity (49%), mental health disorder (25%), hypertension (24%), hyperlipidemia (24%), pulmonary disease (18%), type II diabetes (9%), atrial arrhythmia (5%) and coronary artery disease (3%). Time from infection to presentation (p &lt;0.001), chest pain (p 0.002) and dyspnea (&lt;0.001) demonstrated significant associations with time to improvement of symptoms and were used in the multivariate regression model (F 27.8, p&lt;0.001). The time to presentation predicted the longest time to symptom improvement, followed by dyspnea, chest pain, and dizziness. Conclusions: This analysis of a large group of PASC-CVS patients suggests those who wait longer to seek care for PASC-CVS symptoms may have longer duration of post-COVID symptoms. Additionally, specific symptoms may take longer to improve than others. Patients with PASC-CVS should therefore consider early medical care to mitigate symptoms and reduce duration of post-COVID syndrome.
Abstract 12264: A Rare Case of Penetrating Aortic Ulcer Causing Hemopericardium and Its Management
Authors: Hardik Fichadiya, Rachel Abboud, Muhammad Atif Masood Noori, Abdullah Masood, Sherif Elkattawy, Arshan Khan, Harshwardhan Khandait, Jesani Shruti, Meherwan B Joshi
Journal: Circulation (2022)

Introduction: Penetrating Aortic Ulcer (PUA) is an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows hematoma formation within the medial layer of the aortic wall. As per our literature review, only one case of PUA causing hemopericardium has been reported. Case Presentation 66-year-old male with an unknown past medical history was bought in by the emergency medical services following a cardiac arrest. Initial rhythm was pulseless electrical activity and return of spontaneous circulation was achieved after ten mins of cardio-pulmonary resuscitation on the field. Initial echocardiogram was significant for a 4.6 cm ascending aorta with large hemopericardium causing tamponade physiology. CT chest with contrast revealed an ectatic ascending aorta with mild irregularity along the posteromedial wall, concerning for aortic leak secondary to a penetrating aortic ulcer (as indicated by the yellow arrow in the image below). Controlled pericardiocentesis was planned as a bridging therapy while awaiting transfer to a specialized cardiothoracic unit. But, the systolic blood pressure (SBP) rose to 170 mmHg when the chest tube was first inserted, worsening the hemopericardium. The patient's condition rapidly deteriorated, causing another cardiac arrest and death. Discussion The recommended treatment for Type A and B PUA-associated Intra Mural Hematoma is urgent surgical aortic graft placement. For hemodynamically unstable patients who cannot be taken for urgent surgery, The 2015 European Society of Cardiology guidelines recommend controlled pericardiocentesis to maintain a target SBP of 90 mmHg as a temporary measure. Conclusion In addition to aortic dissection, PAU should be considered in the differentials of patients with dilated ascending aorta and hemopericardium. An acute rise in blood pressure above 90 mmHg during pericardiocentesis is associated with worsening tamponade.
Abstract 12359: Thioridazine Suppresses Endothelial Inflammation and Atherogenesis Through Inhibition of Yap-jnk Signaling Axis
Authors: Minchun Jiang, Huanyu Ding, Li Wang, Yu Huang
Journal: Circulation (2022)

Introduction: Atherosclerosis is a critical public health issue as cardiovascular disease has been on the rise globally for decades. Our previous study found that YAP plays a critical role in endothelial inflammation and atherosclerosis, indicating that YAP is a promising therapeutic target against atherosclerotic vascular diseases. Therefore, we established the drug screening platform, aiming to seek new YAP inhibitors through repurposing FDA-approved drugs. Methods and Results: Drug screening was initially performed by luciferase reporter gene assay. We found that the anti-psychotic drug thioridazine can significantly inhibit the YAP/TAZ activity in human endothelial cells. Thioridazine downregulated the mRNA levels of YAP/TAZ target genes (ANKRD1, CTGF, CYR61) in endothelial cells. Thioridazine also increased the phosphorylation of YAP and inhibited the nuclear translocation of YAP in endothelial cells. Thioridazine suppressed endothelial inflammation, as demonstrated by downregulation of JNK phosphorylation, activity of JNK effector AP-1 as well as mRNA expression of pro-inflammatory markers including JNK target genes. Moreover, we observed that oral administration of thioridazine alleviated the formation of atherosclerotic plaques in ApoE -/- mice on a western diet. Conclusion: Overall, the FDA-approved clinical drug, thioridazine suppresses endothelial inflammation and atherogenesis through inhibition of YAP-JNK signaling pathway. As a novel YAP inhibitor, thioridazine might need further investigation and development for potential use of treating atherosclerotic vascular disease.
Abstract 11437: False Atrial Fibrillation Alerts From Smartwatch in Relation to Perceived Physical Well-Being and Confidence in Management of Chronic Symptoms: The Pulsewatch Study
Authors: Kamran Noorishirazi, Qiying Dai, Edith Mensah Otabil, Ziyue Wang, Darleen Lessard, Jordy Mehawej, Andreas Filippaios, Tenes J Paul, Eric Ding, Syed Naeem, Apurv Soni, Jane Saczynski, Khanh-van T Tran, David D McManus
Journal: Circulation (2022)

Background: Atrial fibrillation (AF) can cause strokes that may be preventable with timely detection and anticoagulation therapy. Smartwatches offer the potential for non-invasive, long-term AF monitoring, but potential implications for psychological well-being associated with these alert systems remain to be studied. We examined the psychosocial impact of false alerts for AF on patients prescribed a smartwatch post stroke. Methods: We analyzed data from the Pulsewatch study (NCT03761394), which enrolled patients ≥50 years from the UMass Memorial Health system who had a history of stroke or transient ischemic attack, CHA 2 DS 2 -VASc ≥2, and no contraindications to anticoagulation. Data from participants in the intervention group, who received a cardiac patch monitor, as well as a smartwatch and smartphone installed with Pulsewatch applications, were analyzed. At baseline and 14 days, participants completed the Health Survey SF-12 to assess perceived physical well-being, and the Symptom Management survey to assess confidence in disease self-management. We employed logistic regression to assess changes in anxiety, perceived mental and physical health, and chronic disease management self-efficacy over 14 days with exposure to false alerts. Results: Among 85 participants who received a smartwatch for AF detection (mean age 64.8±9.2 years, 41% female, 86% non-Hispanic white) 11 (13%) received a false AF alert. Receipt of false alerts was associated with significant decreases in perceived physical well-being and management of chronic symptoms (β = -9.08, p &lt; 0.01 and β = -6.50, p = 0.03, respectively), but not significantly associated with changes in perceived mental health (β = 0.70, p = 0.78). Conclusions: Perceived physical well-being and levels of disease self-management, but not perceived mental health, decreased with exposure to false AF alarms over 14 days. Further studies are required to explore the psychological impact of smartwatch AF monitoring in patients post stroke.